Mind Games

 

 

“Sometimes a cigar is just a cigar,” wrote Austrian psychoanalyst Sigmund Freud. But that was not the case with Radhika, a 30-year-old woman in Hyderabad, who was expected to lead a rather happy life, with a cushy job in a software company and a happy marriage that bore her two children. A few months ago, she began to feel tired without any reason. She also suffered from anxiety attacks, and a sudden feeling of hopelessness engulfed her. Her sleeping pattern changed and she began to neglect her official and household duties. Before someone could notice, the ‘cigar’ became too much to handle for Radhika. She tried to end her life by taking a fistful of sleeping pills. Her husband rushed her to a hospital where the doctors treated her. But no one cared about her mental state. After she had come back home, her family members hoped that she was on her way to recovery. But that was not to be. Within a month she had tried to end her life once again. This time a psychiatrist was involved in her treatment. She was diagnosed with Endogenous depression. “It is a malfunction in the brain chemistry. Features may include change in eating habits, insomnia, lack of interest, depressed mood, fatigue and suicidal thought,” says Dr. V.S. Rajashekhar, a noted psychiatrist of Hyderabad, who treated Radhika. Radhika may be on the road to recovery, but there are so many Radhikas who are silently bearing the brunt, and unsuccessfully trying to come to terms with their inner demons. Prevalence of mental illness worldwide is same as that in India. It differs primarily in the rehabilitation. In advanced countries, besides medicines, infrastructure is very sound. The concept of Half Way Homes and day-care centres are still in infancy. The very few Half Way Homes in metros are very expensive.

The myths about mental illnesses, lack of awareness, stigma attached to it, lack of proper treatment and the apathy of policy makers are big hurdles in the delivery of treatment to the sufferers. Lack of education is also responsible for the high prevalence of the disease.

Abhishek Kumar, a class-twelve student in Patna, was the only hope of his family. His parents always believed that Abhishek would crack the prestigious IIT entrance exams. However, when he could not make it in the second attempt, his family became exasperated. They were not able to decipher the possible reason of his failure. Though they noticed certain aberrations in his behaviour, no one gave it a serious thought. It was only after Abhishek discussed his problems with his family that they took him for counselling. Abhishek was diagnosed with Schizophrenia. After years of treatment, Abhishek now leads a normal life. He is pursuing a degree in computer applications.

The treatment for mental illness has become easier now than it used to be 10-15 years ago. Says Dr. Puneet Dwivedi, consultant Psychiatrist at Max Hospital in Delhi, “Now our understanding of the problems is much more than earlier times. Even medicines are much effective and with less side-effects now.” Apart from medicines, minor corrections in the lifestyle may help reduce the risk of occurrence of disease. Experts advise that a stress-free life may thwart the occurrence of mental illness. Leading a regulated life such as going to bed in time and waking up early morning, jogging and Yoga may be of great help. Adoption of deep breathing helps in releasing the stress. However, due to fast-paced lifestyle, rising peer pressure, growing materialism, highly competitive environment, breaking of support system and inter-personal problems, it becomes all the more difficult to regulate such a lifestyle. But one should try to follow as much as possible, say experts.

Depression is one of the most encountered mental diseases, mostly in urban India. Most of us often fail to recognise its severity. However, its prevalence in the society has reached dangerously high levels. “We often fail to understand the difference between sadness and depression. Sadness does not last for long time. It is short-lived and most of us recover in a day or two. If sadness prolongs for a fairly long time coupled with some other negative symptoms, then it can be depression,” says a noted Bangalore-based psychiatrist. Experts say that women are more susceptible to this disease than men.

There are various factors that can lead to depression. It may be personal shock or trauma or pressure at work place. Says psychiatrist Anita Mahajan, “Depression, if prolonged for a long time, can cause social-occupational dysfunction, personal distress and distress to the society as well.” It is also a misnomer that depression is mainly prevalent in upper-middle and elite class. Anyone can suffer from depression irrespective of economic status.

Depression can be treated successfully. There are effective drugs for the disease. Apart from the medicines, socializing, spending time with the family and friends and cultivating hobbies can help overcome the problem.

It is important to recall the story of the American mathematician and Nobel Prize winner John Forbes Nash. His account of life and lifelong battle with Schizophrenia was beautifully portrayed in A Beautiful Mind in 2001. He went on untangling the disease in formulaic fashion, very similar to a mathematical problem. At one place in the film, Nash says, “There are no problems without solutions. And that’s what I do while solving the problem.” Schizophrenia affects around 1-2 percent of the population and is considered to be one of the most dreadful mental illnesses. It is a disease that affects the thoughts and perceptions of the person and his interactions with others. According to eminent psychiatrist Saara Khan, “Schizophrenic persons loose their ability to use logic. They rapidly change their train of thought. They can have emotional abnormality such as laughing when sad, or might hear some voices that others don’t hear.”

The cause of Schizophrenia is still unknown. There are proteins in the brains, called neurotransmitters. Their imbalance can cause Schizophrenia or some other mental disease. There are various theories to explain the development of this disorder. Genetic factor may play a critical role. If anybody in the immediate family suffers from the disease, children are likely to inherit the disease. Psychological and social factors such as disturbed family and interpersonal relationships may play critical role.

Schizophrenia can be treated with varying degrees of success depending on the type of patient. The older the disease, more resistant it becomes and, consequently, its treatment becomes more difficult. If patient is treated earlier, he can completely recover. In nearly one-third of cases, patients completely recover; in the remaining one-third there are chances that disease may relapse and the last one-third can also lead normal life if they take medicine regularly. Treatment of the disease may take its toll on the family and can cause immense trauma for them.

Says Dr R.K. Chaddha, Professor in the Department of Psychiatry AIIMS, “Patients do not want to take the medicine for lifelong due to stigma attached to it. They do not understand that mental illness is similar to other diseases such as heart blockages and diabetes. People should understand the basic fact that there can be dysfunction in thought as there are problems in other parts of body.” While sharing her experience, Anuradha, a chronic Schizophrenic patient told TSI, “I was late in consulting the doctor. But one should not delay in matters like this.”

Obsessive-compulsive disorder (OCD), Bi-polar disorder, Panic disorder are major anxiety-related disorders. However, OCD is the most common and complex problem. There are symptoms of repetitive actions such as checking the doors, locks, electrical appliances and frequent cleaning of hands or clothes, strict attempt to keep various personal items in perfect order. The exact cause of OCD has not been deciphered. However, shortage of Serotonin (a type of neurotransmitter) in brain is linked with OCD. In one-third of patients, it occurs at the age of fifteen and second peak of incidence can occur during third decade of life. OCD can be treated successfully. If combined with CBT (a type of behaviour therapy) success rate reaches to 85%.

Also, there are no social benefits for the mentally disabled. This worries Anurag Sharma, father of a chronic Schizophrenic child. Expressing his concern, he says, “I am growing old. Who will take care of my son after my death?” Experts opine that even those who take best medicines for Schizophrenia such as Olanzapine or Clozapine can’t claim to be fully cured. People may recover enough so that their families can bear them. There is an urgent need to consider that these mentally-crippled people have a right to dignified life. Therefore, it is the duty of the state to provide them means of livelihood.

Research in the field is geared towards identifying genes that result in certain type of mental disease. Though, various genes have been identified but their relative interactions have not been understood completely. Experts say that there are various internal and external factors, which determine onset of a particular disease. However, advancement in genetic engineering might open the gate of treatment of these dreadful diseases. But more than anything else, it is the lack of awareness and sensitisation of society that needs to be worked upon. After all, the mind can play games with anyone of us. The challenge within

The mental health scenario in India looks scary

Treatment of mental illness in India is a huge challenge as India lacks proper infrastructure. According to the World Health Organisation (WHO) there are 50-60 lakh chronically-ill patients of mental diseases in the country. More than one lakh people commit suicide every year due to acute depression, and a large chunk among these are in their productive years. The figures look even scarier when we come to know that one in every four persons develops one or the other type of psychiatric disorders once in lifetime. 80 percent of patients do not get any kind of clinical support at all. There are only 0.2 psychiatrists per lakh persons. There are hardly 3,500 psychiatrists in the country. Working for the mentally challenged is a challenge in itself. Psychiatrists lament about the government’s apathy towards the problem. There is severe problem of rehabilitation for mentally disabled, though community-based rehabilitation is becoming quite popular these days. Family is also involved in rehabilitation process at various levels. However, this is confined at the NGO level only. The United Nations have also declared rights for the mentally disabled. However, they assume no significance. One major concern is exodus of talented doctors to foreign countries. Many talented doctors have left to seek greener pastures abroad. The National Institute of Mental Health and Neurological Sciences (NIMHANS) has witnessed one such exodus recently.